Recovering after a heart attack

After having a heart attack, people had to come to terms with the emotional impact of what had happened to them (see 'Coping with emotions after a heart attack'). Here we describe how people recovered physically from their heart attack.

Some people were surprised how tired and weak they felt during the first few days or weeks at home. One man described feeling exhausted after walking 50 yards to the newsagent a few days after getting home.

On the day I was discharged, I went for a short walk while I was waiting for my brother to pick me up and take me home and I went for a walk down the corridor, down to the bottom of the hospital to the newsagent's. I felt a bit shaky then because I'm not used to walking because it had knocked the stuffing out of me a bit. So I realised I was going to have to take it really easy for the next few days, few weeks even.

And did you feel, did you have to do that?

Yes I did. I got, I did some light exercise, just walked to the bottom of the street and that. There's some playing fields and I walked there and back. Eventually I got to the newsagent's another day and just did everything at a slower pace, just taking my time gradually I was building up until I could do more and more.

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Profile Info

Age at interview:

66

Sex:

Male

Age at diagnosis:

47

Background:

Retired Conservative Party Agent; Married, 3 children

I felt okay by then. I was pushing the tea trolley around the wards and dishing out the tea and I thought I was okay. However I went to make the bed on the first morning and realised I felt absolutely ghastly and very weak.

I was told not to go out for a few days and by the Saturday when my wife was home, where we lived at the time there was a newsagent about fifty yards away from the door and I went around there with her and found myself absolutely exhausted when I got back.

Others were surprised by how well they felt and could do more than they had expected. One man said he had to be careful not to do too much because he felt so well.

I mean the book suggests, there's a book that we're given, suggests that you may feel let down when you move into the medical ward, and you may also feel insecure when you come home, and neither of those things have happened to me. And indeed since I've been home, I've, although my wife who was off for the first ten days, was at great pains to restrict my movements, I've felt actually, I felt as though I was able to do more than I have been doing, but at the same time not to over exaggerate it.

Although at any one moment you feel as though, well I could just be living normally. I had noticed that you know I've, I've had a need to rest. Just you know, not for very long but I sort of, I need half an hour's rest if I've been doing something in the morning and maybe half an hour in the early evening.

So it is my body's way of saying you know, take it a bit easy. But you know, what I've been encouraged to do is to build up the amount of, well, aerobic exercise, meaning at this stage I think, just sort of good, good walking. And to build it up so that I, within a couple of weeks will get up to about five times a week of half an hour which I mean it's. So it's actually quite useful being off to sort of to do that. So I've certainly been walking about an hour a day.

And of course the other thing that I have to avoid is upper body exercise, lifting things. And that's, that comes home to you, even just if you lift something relatively small. I think you're aware of it. But that again is something you have to sort of be quite disciplined about. Because if you feel fine it's very easy to think oh I'll just move this sofa or something, you know, and particularly if you're at home and you're not normally at home.

At first, most people rested and were cared for by their families while they discovered what they could and couldn't manage. It can be difficult for family members to know how much people should do after a heart attack. Some men felt that their partners were over protective and thought they should be doing less than they themselves felt able to do.

So when you came home, what was it like coming home those first few weeks?

Really hard. I've got three older daughters, and their dad said I wasn't allowed to do anything, couldn't even go out to the washing machine and put the clothes in the washing machine. I wasn't allowed to cook dinner, and it was Christmas time as well. So I sat here and wrote everybody lists for shopping, and everybody lists for Christmas presents, and who was going to cook.

When they - when there was nobody here, or I could hear that there was nobody downstairs, I'd try and creep out to the washing machine, or the kitchen and then I'd get an ache and think, no, I'd get really frightened and better go and sit down again. As days go on you can obviously do a little bit more and a little bit more.

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Age at interview:

51

Sex:

Male

Age at diagnosis:

51

Background:

Farmer/Teacher; Married, 2 grown up children

So I was in hospital ten days and did a successful treadmill, which is sort of passport to get out really. That was easy because I was fit. And went home, you immediately feel very inadequate at home. Of course [my wife] was anxious as well when I got home because it was all down to her then which was worrying and she wouldn't let me do a thing, which was very frustrating. You know I mean, hospital's all on one level, obviously we've got stairs here, to go upstairs.

She said, 'no you're only walking up the stairs once, don't come up and down two or three times for this and that, you're going to bed you're just going to tackle the stairs once a day and this sort of thing.' And I thought, 'well that's ridiculous because I certainly felt a lot stronger than that.' But well I try to do as I'm told [laughs], it isn't easy.

Is that hard then, when you're feeling well?

Yes, yes it is and I felt oh don't make a fuss. Please don't make a fuss. In a way that made me feel worse. It made me feel an invalid and I wasn't an invalid but [my wife] was only taking good care of me, which was wonderful.

One man commented that his wife had been very worried, she didn't want to let him out of her sight and he had to buy a mobile phone (see 'How it affects carer's'). Another said that other people didn't know how to treat him when he began to be more active again.

So I think people thought that you know I should behave like an invalid perhaps or try to wrap me in cotton wool a bit. But you know with the best of intentions, but people don't, people don't know what having a heart attack is like so they don't really know how to treat you afterwards.

How did that make you feel being wrapped in cotton wool?

It's a bit frustrating, especially when the reason you're sort of out is because you're making another step, or you have made another step to get away from the sort of the twenty four hour care down to the sort of fourteen hour care from [my wife] and then [my wife] going back to work, and my mum stopped coming down to make sure I was alright and by the time I was going out you know I felt fine and I was driving and whatever.

So you know it was a bit frustrating but it didn't happen very long and I think you know that it's done with the best of intentions.

As people got stronger they began by walking short distances and built up their strength by walking further each day. Some people found it difficult to make themselves go for walks, preferring to stay at home and watch the world go by. One man explains that although he felt concerned and conscious of any changes in his body when first went walking, he thought it was important not to be too cautious or over worried.

But, you know, at first I didn't even want to get out and walk, because you had to walk, you know, every day and do this, that and the other. At first I wouldn't even want to walk outside the door and then after a little while, you know, I started going for little walks and doing this and that and the other.

But, I went out for a walk yesterday but that was the first time in a week because I'd been in hospital and that so I know I've got to, you know, slowly go and do things again now. It's so easy not to do it, though.

It's so easy like just to sit back and just watch the world go by and not be a part of it, it's just, sometimes it's easier just to sit in here and watch everybody else than go out there and do it yourself. So I have to push myself, I do have to push myself.

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Age at interview:

54

Sex:

Male

Age at diagnosis:

54

Background:

Senior Manager, Local Government; Married, 3 children

But I suppose the important thing in terms of recovery I think is not to do ridiculous things, but also I think not to be over cautious and over worried because you know. I mean the reality is that if you are too cautious and over protect yourself you're actually counterproductive. That the things you need to do are actually to lead a normal life, to exercise. That mollycoddling is not the answer.

You know, you shouldn't be doing weight lifting for example because that's, that's going to really mess you up. But I can understand possibly why some people are scared and frightened of trying out things. And the day that we came out of hospital, we went for a walk in a local arboretum.

And for the first mile or half mile or so I was thinking am I feeling anything and the reality is you're not. I mean that you have to be monitoring if you know, you don't do things that feel wrong. But I think that the other thing is that you can't spend your life protecting yourself from things that you have to do as being part of your ordinary life.

Many said that attending a cardiac rehabilitation programme four to six weeks after their heart attack had helped them to build up their strength and get fit (see 'Cardiac rehabilitation and support').

Some people were very conscious of any twinges or the odd chest pain and were frightened by them. One man explains that he was more aware of feelings in his body after he had a stent fitted, and he would worry about them during the night. Another said there were some nights when he was too frightened to go to sleep because he had chest pain.

Yes I think that was the main anxiety at the time. I used to get any slight twinges in my chest, it might just be a slight, probably just a bit of muscle cramp or something and I'd worry if that was the start of something.

And when that happened, did you speak to your doctor about it?

Not straight away. Well I did when I went for the blood pressure check and he tested it with his stethoscope and he couldn't find anything. He couldn't detect any abnormalities.

Did you have those twinges very often?

Not very often, no, just now and again. That was it mainly, it was just probably sat or laid down in an awkward position. It would only last maybe a few seconds. Again in the books, it said if it lasts up to twenty minutes then you've got a problem. So after a while I stopped worrying about it.

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Profile Info

Age at interview:

67

Sex:

Male

Age at diagnosis:

65

Background:

Retired Training Officer; Married, 5 children

When you're in hospital, you're in the situation where you don't get a lot of sleep anyway. And I thought, well once I get home, you know, I'll get in my own bed and all the rest of it, I'll be all right. That's all right but, as I said, you get these little niggly things that goes on and if you have a tendency to feel more, you're feeling what's going on in your body whereas before you may not have felt them, not noticed them as much even.

So, when I had the stents put in, I don't know whether it was like the stents settling in but I used to get these little itchy, as though you wanted to scratch inside. I know it's avery funny, funny feeling. It wasn't funny at the time like, I mean, and, I would wake up suddenly through the night feeling there was like a pressure, pressure on my chest.

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Profile Info

Age at interview:

58

Sex:

Male

Age at diagnosis:

57

Background:

Retired Psychiatric Care Assistant; Married, 4 children

I think literally when I came out of hospital first time, that was such a common thing. I mean, I'd go straight to bed if I was feeling alright, just a bit uncomfortable. But if there was a bit more than just uncomfortable, I shut my eyes, I'm never going to wake up, so what I'll do is I won't shut my eyes, and I know it's absurd, but it's a fear that's engendered within you and I try to put it to people in the sense, it's not the intensity or lack of the pain, it's the source of the pain that's the worry.

Like if you broke your arm in several places and it's cripplingly painful, it's your arm but when your heart hurts, it's kind of, it's the pump that drives the engine kind of thing. You find it really quite frightening and I know it's absurd, I'm not going to go to sleep and two or three hours later you're still awake worrying and that fear was difficult to deal with.

Of those we interviewed many said their life was disrupted for several months, while they recovered, or waited for tests or treatment. One man who had waited nine months for an angiogram wanted to get the test done soon, so that if treatment was necessary it could be done as soon as possible. Another women didn't feel confident to do too much during the three months she waited for an angiogram. One man, who had complications, felt that the first six months were filled with medical appointments, convalescence and restrictions. Another said that during the first year, achieving different milestones helped him feel that he was getting back to normal.

I was very, very anxious all the time. I was very, very down. I didn't want to do anything, as much as they encouraged me to go out walking and do bits and pieces, I didn't want to do anything. The only thing I didn't mind doing was going to the hospital, twice a week it was at the time, to go to my rehabilitation class because I was round professional people and they could help me if anything went wrong so it's confidence.

You've got no confidence to go out and do anything because, you know, you're always panicking and any little pain that you get, you think, oh my gosh, you know what I mean? Is anything else going to happen so that was, that was the worst, was waiting. Because if I'd had one heart attack and they hadn't treated the cause, then you know, was I going to have another? So that was the worst thing, was waiting to have that done and that was a long few months, that was, waiting.

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Profile Info

Age at interview:

63

Sex:

Male

Age at diagnosis:

62

Background:

Retired computer manager; Married, 2 children

Although it was probably only a minor heart attack, it just felt like a major production at the time - the immediate impact was huge. The first six months or so afterwards seemed to be dominated by restrictions, remedial activities and medical appointments. But because it wasn't a severe attack I was able to gain some degree of physical ability and confidence quite quickly.

After a week at home I started taking gradually lengthening daily walks, and I got involved in rehabilitation activity as soon as I could. In the first year afterwards we had three B&B holidays, of about a week each, touring parts of the UK we hadn't been to for years. Had it not been for the problem with blood circulation in my arm, I would by now be as near back to normal as I am ever going to be - though I have worked fairly hard at it.

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Profile Info

Age at interview:

51

Sex:

Male

Age at diagnosis:

51

Background:

Farmer/Teacher; Married, 2 grown up children

You want to get back to normal as I said before, that helps you cope as well. I didn't enjoy having a month without driving although I could see that was sensible but you want to get back to normal, that helps you. As soon as I could start to drive myself, even though I didn't go very far, just up to the village for the papers or something like that.

That was a big boost, you say, 'Oh I'm getting better, I'm getting back to normal.' And then going back teaching, going back to work is a big, big hurdle as well. And the first few days you think, 'Oh gosh, how am I going to cope with this,' but that goes well and it helps you mentally. And so I've been out teaching for the day, I come back and I haven't thought about my heart for the day.

Whereas when I was at home, that's all you did think about to be honest you know, you tried to listen to the news and read the paper and so on but it's always in the back of your mind that you know there's something wrong with your heart. But as soon as you get distracted by your work or things that are going on and you can participate of them, it does help to get over a heart attack.

Some people started having angina, or breathlessness, or they tired more easily, which affected what they could do, or they did what they had done before, but just at a slower pace.

Some who had had a more severe heart attack, found that it took longer to recover. One man slept for two to three hours each afternoon for several months after his heart attack. Another said it took a long time to recover and now because of heart failure he has limitations. A third man, who also has Cardiac Syndrome X, talks about the physical limitations he has.

When you first came home at Christmas time, what was it like those first few days at home?

Well, difficult in so far in that I didn't like, I've always been one that's helped around the house. We've worked and done things together. The main problem was sitting not being able to do my share shall we say.

How did that change over time?

Just as I became a little stronger and able to do things. I started to do different things without sort of taxing myself too much and just worked up until I was helping around the house just as I used to do. But of course it took time to build up to that point and in an afternoon, originally when I first came out, I certainly had to go to bed.

They did recommend I had a lie down and in the afternoon I did have to go to bed and sometimes it was two, three hours, sometimes more. And of course during the winter months one of the problems was I couldn't keep myself warm, my feet particularly because of the low blood pressure. I used to go to bed, get wrapped up, get my feet wrapped up in blankets and a hot water bottle and I used to manage to get some sleep.

But I must admit once I went to sleep, I could be there three hours or so. On odd occasions, my wife's came in to monitor, to see if I was okay. I suppose there were times when she was in and out without me realising to see if I was okay because I used to be sound asleep and I found for quite some time it was part and parcel of the day's regime.

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Profile Info

Age at interview:

39

Sex:

Male

Age at diagnosis:

37

Background:

Retired manager; Married, 2 children

-This has been going on two and a half years now, you know because as I say it was May 2001 so this has been going on a while, most of their lives. And initially it was very bad, because you couldn't do hardly anything because physically you just couldn't move.

Now I can do more, but I just have to make sure I get rest and I have to be careful of not doing too much or putting, cause I think when I walk, unfortunately round here it's hilly, as you've seen no doubt when you were driving. And they say well you can go out for a short walk on the flat.

Get me to the flat first, then I'll do me short walk [laugh], I can't [laugh], I either start up the hill or go downhill and I've got to turn round and come back up, and when I go out for walks yes I can get, it starts, so I have to stop and ease off.

It's not so much fibrillation but you, you can get ectopics, what I feel are ectopics. It starts beating suddenly very quick, you know. Not as if under normal exercise it gradually it gets quicker, it could just be going along and I'm not out of breath.

Again this is probably the other side that my respiratory system is probably still very efficient and that's what made you a good runner, so I probably get oxygen passed through very well it's just unfortunately that the blood's not as good as, as getting rid, passing it along.

So I'm not out of breath and I'll suddenly go from probably feeling 90 beats per minute to [noise] you know, well over 140, 150, so I just have to stop. Now what suddenly triggers that I don't know it just, suddenly it happens, and so you play wise, you stop, calm down and try and, and set off again.

And that kind of thing I find frustrating, cause obviously I've always been intensely physical, was competitive, the competitive side which probably going to go as you get older anyway but I was intensely physical, you know. I used to love just running up the hill or a mountain if it was there and [pause] now I can't walk without having to stop, it's such a change it's quite frustrating.

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Profile Info

Age at interview:

58

Sex:

Male

Age at diagnosis:

57

Background:

Retired Psychiatric Care Assistant; Married, 4 children

I think they're all predominately, they're all predominately physical things, like DIY, gardening, long walks and it's not the individual task that you can't do, it's the sum total of all of them. We've got a grandchild and you play with her and prior to it, I could run around the garden with her, I can't now.

And it's all those things, all those other physical things because psychologically your heart attack hasn't affected your brain as it were, but they're all physical things that you can't do and at times you get really stupid and do something you really shouldn't have done but if there is a good side to it, the pain soon tells you that you shouldn't be doing that.

And it was that, all physical related tasks that were very, very difficult, either very difficult or you couldn't do, and you knew you weren't to. But gradually with the acceptance of all things, I think, otherwise you'll keep on beating yourself up as you discover new tasks that you can't do but could of done, if I can't do it, sit down, someone else will do it for me.